Duration of Hospital Stay and Influence on the Period between Hospitalizations of Patients

Abstract

The purpose of the study. The article presents and substantiates the possibilities of reducing the risk of rehospitalization on the basis of a specially developed econometric model of behavior of the hospital doctor in conditions of different workload of patients using the schedule according to Slutsky. Materials and methods. The effects of the model showed that the growth of the competitive environment leads to: a) a decrease in the number of services provided by the hospital doctor; b) switching to perform functions that help improve the quality of the treatment process; c) an increase in the average duration of treatment. Modern tendencies are shown: a) reduction of the number of doctors of inpatient departments; b) increasing the workload of the hospital doctor with patients and bed-days; c) reducing the average length of stay in the hospital. Results and discussion. The economic mechanisms of reducing the risk of re-hospitalizations are substantiated, namely: a) compensation of the turn of the profit curve through compensatory mechanisms of payment for the quality of work of the hospital doctor; b) increasing the price elasticity of consumer demand for stationary services. That is, we chose the length of the period between regular hospitalizations of patients as a criterion for the quality of inpatient treatment. This criterion is essentially equivalent to the risk of re-hospitalization, in which hospitalization in a department of the same profile, which confirms the failure of the previous treatment. Thus, a link is expected between a longer stay of the patient in the hospital and a lower risk of re-hospitalization, provided that a longer stay will provide additional quality of treatment. Therefore, the discovery of such a connection is a confirmation of the hypothesis, which is based on the theoretical econometric model of physician behavior and relates to the reorientation to the additional quality of inpatient care in a competitive environment. That is, due to the increased load, the doctor reduces the length of the patient's stay in the hospital and therefore the quality of care deteriorates. Due to the fact that the discharge of the patient involves achieving a stable condition, doctors are sometimes forced to give an objective assessment of the condition at the time of discharge. The timeliness of evaluating effectiveness is the possibility of temporary relief when in fact the case of treatment is not over. It should be noted that in countries with a private health care system, reimbursement of hospital care costs is related to the number of bed-days spent by the patient in the hospital, where "day" is defined as the period from one midnight to the next, medical staff can manipulate the time of hospital discharge, as patients who are kept until midnight will have an additional day to reimburse. Conclusion. It follows from the research results that a reduction in the length of hospital stay in the existing situation significantly worsens the prognosis, increasing the risks of an uncontrolled course of the disease and, accordingly, subsequent hospitalizations